Тромбоз, гемостаз и реология

Tromboz, Gemostaz I Reologiya
scientific and practical journal

ISSN 2078–1008 (Print); ISSN 2687-1483 (online)
2020, COVID
2020

New coronavirus infection, hemostasis and heparin dosing problems: It is important to say now: 616-005.6:616.151.5

COVID
Published 2020-06-22
Andrey Yu. Bulanov
City Clinical Hospital No 52, Moscow Healthcare Department; 3 Pekhotnaya Str., Moscow 123182, Russia
ГБУЗ «Городская клиническая больница № 52 Департамента здравоохранения города Москвы»; Россия, Москва 123182, Пехотная улица, 3;
https://orcid.org/0000-0001-6999-8145 (unauthenticated)
Eugene V. Roitman
Russian National Research Medical University named after N.I. Pirogov, Health Ministry of Russian Federation; 1 Ostrovityanova Str., Moscow 117997, Russia; Research Center of Neurology; 80 Volokolamskoe Highway, Moscow 125367, Russia
ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской Федерации; Россия, 117997 Москва, ул. Островитянова, 1; ФГБНУ «Научный центр неврологии»; Россия, 125367 Москва, Волоколамское шоссе, 80
https://orcid.org/0000-0002-3015-9317 (unauthenticated)

Keywords

hemostasis
COVID-19-associated coagulopathy
fibrinogen
low molecular weight heparins
  Full Text

Abstract

In the absence of a sufficient base of evidence-based medicine, the most valuable becomes the expert’s opinion as a mirror of both personal and collegial experience. COVID-19-associated coagulopathy has a character of a thromboinflammation. The heparins — unfractionated or mainly low molecular weight heparins (LMWH) are intended to overcome it, since heparins have not only an anticoagulant effect but both an indirect and direct anti-inflammatory effects as well. So that LMWH are indicated for all in-hospital patients. Patients with COVID-19, especially in severe cases, require laboratory testing of platelet count, D-dimer, prothrombin ratio or prothrombin percents by Quick and fibrinogen. Data analysis showed that a feature of coronavirus hemostasis is hyperfibrinogenemia that becomes an overt factor for heparin resistance. To overcome the latter, an adjusting doses of LMWH toward intermediate or therapeutic looks like a promising way. The sufficiency of the adjusted LMWH dose is appropriate determining either with anti-Xa activity or thromboelastographically as express testing.

REFERENCES

  1. Scores and Algorithms in Haemostasis and Thrombosis. Eds. E.V. Roitman, N. Yu. Levshin. [Tromboz i gemostaz. Shkaly i algoritmy. Pod red. E.V. Rojtmana, N. Yu. Levshina]. Paris, France: Diagnostica Stago, 2016. 62 s. (In Russ.).

  2. ZabolotskikhI.B., Kirov M.Yu., AfonchikovV.S. et al. Perioperative management of patients receiving long-term antithrombotic therapy. Russian Federation of anesthesiologists and reanimatologists guidelines. [Perioperacionnoe vedenie pacientov, poluchayushchih dlitel’nuyu antitromboticheskuyu terapiyu. Klinicheskie rekomendacii Federacii anesteziologov i reanimatologov]. Vestnik intensivnoj terapii imeni A.I. Saltanova. 2019;(1):7–19. (In Russ.). DOI: 10.21320/1818–474X-2019–1–7–19.

  3. Thachil J., Tang N., Gando S. et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Hemost. 2020;18(5):1023–6. DOI: 10.1111/jth.14810.

  4. Tang N., Bai H., Chen X. et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Hemost. 2020;18(5):1094–9. DOI: 10.1111/jth.14817.

  5. Thachil J. The versatile heparin in COVID-19. J Thromb Haemost. 2020;18(5):1020–2. DOI: 10.1111/jth.14821.

  6. Cattaneo M., Bertinato E., Birocchi S. et al. Pulmonary embolism or pulmonary thrombosis in COVID-19? Is the recommendation to use high-dose heparin for thromboprophylaxis justified? Thromb Haemost. 2020 Apr 29. DOI: 10.1055/s-0040–1712097. [Online ahead of print].

  7. Tang N., Li D., Wang X., Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844–7. DOI: 10.1111/jth.14768.

  8. Yin S., Huang M., Li D., Tang N. Difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non Sars-CoV2. J Thromb Thrombolysis. 2020 Apr 03;1–4. DOI: 10.1007/ s11239–020–02105–8. [Online ahead of print].

  9. Interim guidelines «Prevention, diagnosis and therapy of new coronavirus infection (COVID-19)». Version 6 (28.04.2020). [Vremennye metodicheskie rekomendacii. Profilaktika, diagnostika i lechenie novoj koronavirusnoj infekcii (COVID-19). Versiya 6 (28.04.2020)]. Ministerstvo zdravoohraneniya Rossijskoj Federacii, 2020. 165 s. (In Russ.). Available at: https://remedium.ru/legislation/other/Vremennye_metodicheskie_rekomendatsii_profilaktika_diagnostika_i_lechenie_novoy_covid_19_v6/. [Accessed:25.05.2020].

  10. NekhaevI.V., Prikhodchenko A.O. Options for monitoring and correcting hemostasis in cancer patients: monograph. [Varianty kontrolya i korrekcii gemostaza u onkohirurgicheskih bol’nyh: monografiya]. Moskva: ABV-press, 2019. 135 s. (In Russ.).

  11. Falati S., Liu Q., Gross P. et al. Accumulation of tissue factor into developing thrombi in vivo is dependent upon microparticle Pselectin glycoprotein ligand 1 and platelet P-selectin. J Exp Med. 2003;197(11):1585–98. DOI: 10.1084/jem.20021868.

  12. Gierer P., Laue F., Hoffmann J.N. et al. Antithrombin reduces inflammation and microcirculatory perfusion failure inclosed softtissue injury and endotoxemia. Crit Care Med. 2013;41(3):867–73. DOI: 10.1097/CCM.0b013e3182742d2c.

  13. SinkovS.V.,RoitmanE.V.,ZabolotskikhI.B.Newcriteriaforsepsisinduced coagulopathy. Review. [Novye kriterii sepsis-inducirovannoj koagulopatii]. Vestnik intensivnoj terapii imeni A.I. Saltanova. 2019;(3):52–7. (In Russ.). DOI: 10.21320/1818–474X-2019–3–52–57.

  14. Yan Y., Ji Y., Su N. et al. Non-anticoagulant effects of low molecular weight heparins in inflammatory disorders: A review. Carbohydr Polym. 2017;160:71–81. DOI: 10.1016/j.carbpol.2016.12.037.

  15. Mousa S.A., Petersen L.J. Anti-cancer properties of low-molecular-weight heparin: preclinical evidence. Thromb Haemost. 2009;102(2):258–67. DOI: 10.1160/TH08–12–0832.

  16. Yalniz M., Demire U., Orhan C. et al. Nadroparin sodium activates Nrf2/HO-1 pathway in acetic acid-induced colitis in rats. Inflammation. 2012;35(3):1213–21. DOI: 10.1007/s10753–012–9431-z.

  17. Lee J.H., Lee H., Joung Y.K. et al. The use of low molecular weight heparin–pluronic nanogels to impede liver fibrosis by inhibition the TGF-β/Smad signaling pathway. Biomaterials. 2011;32(5):1438–45. DOI: 10.1016/j.biomaterials.2010.10.023.

  18. Haoa C., Sunb M., Wangc H. et al. Low molecular weight heparins and their clinical applications. Prog Mol Biol Transl Sci. 2019;163:21–39. DOI: 10.1016/bs.pmbts.2019.02.003.

  19. Galstyan G.M., Shutova N.A., Gorodetsky V.M. Antithrombin III in

    the treatment of sepsis — new approaches to prescribing the old drug. [Antitrombin III v lechenii sepsisa. Novye podhody k naznacheniyu starogo preparata]. Anesteziologiya i reanimatologiya. 2007;(6):66–71. (In Russ.).

  20. Abildgaard U. Biological action and clinical significance of antithrombin III. Am J Hematol. 1984;16(1): 77–9.

  21. Roemisch J., Gray E., Hoffmann J.N., Wiedermann C.J. Antithrombin: a new look at the actions of a serine protease inhibitor. Blood Coagul Fibrinolysis. 2002;13(8):657–70. DOI: 10.1097/00001721– 200212000–00001.

  22. Opal S. M. Interactions between coagulation and inflammation. Scand J Infect Dis. 2003;35(9):545–54. DOI: 10.1080/00365540310015638.

  23. Levi M., van der Poll T. The role of natural anticoagulants in the pathogenesis and management of systemic activation of coagulation and inflammation in critically ill patients. Semin Thromb Hemost. 2008;34(5):459–68. DOI: 10.1055/s-0028–1092876.

  24. Levy J.H., Sniecinski R.M., Welsby I.J., Levi M. Antithrombin: antiinflammatory properties and clinical applications. Thromb Haemost. 2016;115(4):712–28. DOI: 10.1160/TH15–08–0687.

  25. Levshin N.Yu., Roitman E.V., Arshinov A.V.,Pechennikov V.M.Dipyridamole: the rearguard on proscenium. [Dipiridamol: ar’ergard na avanscene]. Tromboz, gemostaz i reologiya. 2019;(2):12–22. (In Russ.). DOI: 10.25555/THR.2019.2.0875.

  26. Balakumar P., NyoY.H., Renushia R. et al. Classical and pleiotropic actions of dipyridamole: Not enough light to illuminate the dark tunnel? Pharmacol Res. 2014;87:144–50. DOI: 10.1016/j. phrs.2014.05.008.

  27. Interim guidelines «Prevention, diagnosis and therapy of new coronavirus infection (COVID-19)». Version 7 (03.06.2020). [Vremennye metodicheskie rekomendacii. Profilaktika, diagnostika i lechenie novoj koronavirusnoj infekcii (COVID-19). Versiya 7 (03.06.2020)]. Ministerstvo zdravoohraneniya Rossijskoj Federacii, 2020. 166 s. (In Russ.). Available at: http://mpmo.ru/content/2020/06/Metodicheskie-rekomendatsii-Minzdrava-RFversiya-7.pdf. [Accessed: 03.06.2020].

  28. Connors J.M., Levy J.H. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost. 2020 Apr 17. DOI: 10.1111/jth.14849. [Online ahead of print].

  29. Cohoon K.P., Mahe G., Tafur A.J., Spyropoulos A.C. Emergence of institutional antithrombotic protocols for coronavirus 2019. Res Pract Thromb Haemost. 2020 Apr 28. DOI: 10.1002/rth2.12358. [Online ahead of print].

  30. Alessandroa C., Lorenzob A., Annec A.S. et al. Suggestions for thromboprophylaxis and laboratory monitoring for in-hospital patients with COVID-19. Swiss Med Wkly. 2020;150: w20247. DOI: 10.4414/smw.2020.20247.

  31. Belen-Apak F.B., Sarialioglu F. The old but new: Can unfractioned heparin and low molecular weight heparins inhibit proteolytic activation and cellular internalization of SARS-CoV2 by inhibition of host cell proteases? Med Hypotheses. 2020 Apr 20;142:109743. DOI: 10.1016/j.mehy.2020.109743. [Online ahead of print].

  32. Guidelines. Anesthetic and resuscitation support for patients with a new coronavirus infection COVID-19. Approved by the Presidium of FAR 05.05.2020. Russian Federation of Anesthesiologists and Reanimatologists, 2020. 183 s. (In Russ.). Available at: http://www. far.org.ru/newsfar/496-metreccovid19. [Accessed: 25.05.2020].